I have too much upper eyelid space. What can I do? (photos)

Question

I have way too much upper eyelid space. No, I do not have ptosis or any problems with my eyes. I do NOT use my eyebrows to compensate - it's simply the fat storage that is empty! I've looked into fillers into the upper eyelids but I'm very scared of the dangerous side effects, since if it gets accidentally injected into one of my veins it can cause blindness in rare cases. And even if there's just the smallest chance I'll go blind, I don't want to do it. What are my options?

Paul Lanfranchi, DO, FAOCOO · Answer

Hi there. The only reasonable option for your issue is to fill the area with "something". That "something" can be artificial filler (ie Juvederm or Restylane) or your own body's fat (autologous fat transfer). You already mentioned the potential risks of artificial injections with sharp needles. Although this is a very low probability, it still is a possibility. I would suggest that fat transfer is a better option for two reasons. Number one - The technique used to place the fat involves using blunt cannulas (not sharp). These have less chance of trauma and complications. Number two - fat transfer has a permanent nature to it. This reason alone (obtaining some permanent result) is worth investigating fat transfer simply because with a good treatment you would not need ongoing continuous injections (which cost money and carry a cumulative risk). Hope this helps!

Jed H. Horowitz, MD, FACS · Answer

#Eyelid surgery : high crease and excess lid showthe treatment is #fillers,  either HA or fatyes , there is concern about complication although rarethe results can be amazing

Mehryar (Ray) Taban, MD, FACS · Answer

You are a good candidate for filler or fat injection in the upper eyelids.  There has never been a reported case of blindness with filler injection in the upper or lower eyelid area. See an oculoplastic specialist.  See link below for more information and manuscript I have published on upper eyelid filler injection.

Kenneth D. Steinsapir, MD · Answer

This makes the upper eyelid space look very hollow.  A detailed clinical assessment is needed to determine if you would benefit from bilateral upper eyelid ptosis repair to correct your early levator dehiscence ptosis.  I recommend seeking out the care of a fellowship trained oculoplastic surgeon focused on aesthetic eyelid surgery.

Aric K. Park, MD · Answer

First I would recommend you find a photo of yourself from 10-20 years ago. if you are considering filling out this area, it is helpful to know what you previously looked like and what you will tolerate. Filling should be done with a blunt tip cannula to minimize the risk of inadvertent injection into a blood vessel. Fat or filler are equally good options with positives and negatives to both.

Lily Lee, MD · Answer

I agree with your assessment even though the photo is very close up. Adding volume to the area is the answer, but I understand your concern about the very small risk of intra-arterial penetration causing blindness - which can happen no matter the material placed, fat or hyaluronic acid filler. We try to mitigate this in 3 ways. 1. Blunt cannula technique - nothing sharp, so it injected material simply pushed into avascular space. 2. Injecting against the bone where there is a rather vascular space.3. Injecting incredibly small aliquots to any one area at a time. This is very technique driven and you want to make sure whoever is doing this is skilled and experienced. Filling of the peri orbital area should be thought of as spray painting rather than caulking. Finally, in the event that something untoward should happen, make sure that the facility you go to is equipped with reversal agents and has ophthalmology colleagues nearby. Best of luck to you!

I have too much upper eyelid space. What can I do? (photos)

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